Helping children with brain injury and neurodisability
Every Tuesday morning, LOC senior orthotist Alan Hews visits The Children’s Trust’s School and the specialist paediatric brain injury rehabilitation centre at The Children’s Trust, Tadworth, Surrey, to work as part of a multi-disciplinary team helping children and young people with brain injuries and neurodisabilities.
Here, he explains what his work involves, the challenges he faces and why he loves it.
What does your work at The Children’s Trust involve?
I primarily work within The Children’s Trust School. Every week a clinic list is published and I see patients to check on the orthotics that we have provided. This can be anything from shoe orthotics to spinal braces. Children grow, of course, which means that over time their orthotics need adjusting or replacing. It’s only one morning a week but it’s extremely busy!
How broad is the range of conditions you treat?
I see children and young people with a very wide range of conditions and levels of ability within The Children’s Trust School.
How can orthotics help children with brain injuries?
Children with a neurodisability, or after a brain injury, often have difficulty in controlling the position of their body, so we can use orthotics to help support limb function and give them back some of their independence.
For instance, we can use hand-positioning braces to help children hold a spoon. Alternatively, a spinal jacket can help support a child’s body and help them develop their head control. Often when wheelchair-bound the spine begins to weaken and curve, which can have an impact on lung function. Spinal jackets are helpful in keeping the back and chest straight.
We also use orthotics to try and prevent deterioration of limb function. For example, if a child has an injury that causes them to scrunch their hand, that scrunching may get so bad over time that the hand becomes fixed in that position and, therefore, redundant. At The Children’s Trust, I work with the physiotherapists to develop a holistic approach and create braces and splints that can maintain positions that are encouraging function.
How do advances in technology help you do your job?
We are working on a new way of scanning children to create spinal braces. Typically, we’d create a plaster of Paris mould, which can be very challenging. We can now use an iPad with an attachment that clips over the tablet’s camera to allow us to take a series of 3-dimensional photographs to create a full scan. That’s sent to our manufacturing unit where a special robotic arm produces a lightweight piece of carved foam. Unlike the heavy plaster of Paris mould, we can keep adjusting until we’re ready to make the final brace.
What are the challenges when visiting the clinic at The Children’s Trust?
Every child is unique which means that every prescription needs to be thought through and cross-compared with what has been before. That’s a challenge. All it takes is for one muscle group to be affected in a slightly different way and you can find yourself having to redesign your whole orthotic. So every child needs to be thoroughly examined, their braces designed and then that design needs to be critiqued. Only then will we make the final orthotic.
The other challenge is simply that I see some of these children over a matter of years. The children range in age from about five to 19 years – so you get to know them and see their challenges, which can be tough emotionally. But, it’s also a really good thing because it means I can constantly learn from what’s been done in the past to keep improving their quality of life. That can be really rewarding.
To find out more about the work of The Children’s Trust, or if you are interested in supporting this charity, visit www.thechildrenstrust.org.uk.